Proven Practice: communicating with service users and their carers

Proven Practice: communicating with service users and their carers

The Social Care Institute for Excellence’s weekly analysis of research findings focuses on communication

Most of us take for granted our ability to communicate. We talk to other people and observe their responses. We hear and understand what they say. It is only when our usual ways of communicating do not work that we seek alternatives. For example, if we are visiting abroad and unable to speak the local language, we may communicate with gestures and signs. Or we rely on other people, with the language skills we lack, to act as interpreters. Such experiences are a reminder that our ability to communicate is always provisional. It depends on context and environment, on our abilities and skills and those of the people we are communicating with.

Without effective communication skills social practitioners will be less able to:

● Find out what service users, carers or other practitioners think and feel.

Social care practitioners who communicate effectively draw on many skills. Verbal communication and the use of effective language is just one. Communication may also be non-verbal and refers to conscious and unconscious ways of communicating without words. For example: body language such as facial expression and gesture positioning and personal presentation and dress.

Non-verbal communication

People’s non-verbal behaviour can reveal their underlying feelings and this may be as important as what they say. It may even contradict what they say. When people are less able to communicate verbally and/or directly such observations by practitioners are even more vital – for example, children who do not yet have the vocabulary or cognitive skills to convey what they are thinking and feeling and people with severe learning disabilities, dementia or mental illness. Good observational skills are essential in order to understand non-verbal communication.

Silence is also a form of communication. It may be uncomfortable but, used skilfully, is vital to communication. It provides essential space for thinking and self-reflection. It may indicate significant thoughts or feelings that a person is finding difficult or impossible to express. Practitioners need to know what a person who uses services thinks, feels and believes, both for the formal assessment process and as a means of developing a good working relationship.

While direct questioning might help practitioners acquire some kinds of information for assessments, this does not always feel straightforward to the person on the receiving end. Depending on their circumstances, some may feel that they are expected to give a particular kind of answer, or are wary about hidden agendas. Others may feel bombarded by the questions, unsure of what to answer, or find the questions intrusive.

Leading questions

Questions can lead people in a certain direction and limit what they say, so practitioners may find out only what the questions are designed to elicit rather than what it is they need to know. This can reflect a worker’s own presuppositions. For example, if the practitioner asks a service user what he or she is struggling with, she is more likely to hear about their difficulties rather than their strengths. Wherever possible, to get the fullest and most accurate picture, practitioners should encourage people to communicate their views, thoughts and feelings at their own pace and in their own words.

Depending on their circumstances and the consequences of information being known, some people may withhold or even falsify information. For example, if a mother is asked by a practitioner if her husband has caused her bruising, she might lie for fear she will be seen as a parent who can’t protect her children and therefore they will be taken away from her. A practitioner needs empathy in a situation such as this. Empathy is an important element of communication skills. By understanding and appreciating another point of view, a practitioner will be able to offer more effective support to the people they work with.

Messages for practitioners

● People who use services and carers can feel powerless when they become involved with practitioners, so it is important that their expertise and views are recognised and respected. Practitioners also need to be honest about their own views and concerns. Communication has to be a two-way process.

● Adults and children need to feel safe with someone if they’re going to talk about the things that are worrying them, or are private, or they feel embarrassed or ashamed about. The more practitioners can build up a trusting relationship with people who use services, the more they are likely to feel able to lower some of their barriers and be more open about what they are feeling.

● People need to understand and make sense of information so it is the responsibility of the practitioner to enable clear communication. For example, by not using jargon or words or concepts that are complicated or obscure.

● Direct questioning is not always the most effective way of putting people at ease and finding out information. Questions may lead to short and uninformative responses that don’t tell the practitioner what they really need to know.

● It is easy to miss important information in an assessment because people do not always directly convey what is important because of their situation, feelings, capabilities and previous experiences.

Research abstracts: communication skills

Author WARD Richard et al

Title A different story: exploring patterns of communication in residential dementia care.

Reference: Ageing and Society, 28(5), July 2008, pp.629-651.

Abstract This article reports findings from a three-year project that explored communication in dementia care settings. The project set out to identify the constituent elements of dementia care practice and the patterns that characterise day-to-day relations in care homes. The tightly prescribed and standardised nature of the interactions between staff and residents is described: it raises questions about how dementia care can be truly person-centred. The project found that people with dementia are capable of communication, and invest much effort in seeking to engage those around them, but are excluded from the monitoring, planning and provision of care in ways that the authors argue are discriminatory. The case is made for promoting and supporting communication as key skills and competences for care workers. The value of measuring the level and quality of communication as a means to evaluate care is demonstrated. The authors question the priorities that currently guide care practice and argue that people with dementia need to be listened to and that re-evaluation of what lies at the heart of dementia care is needed.

Author SAMUEL Judith et al

Title An evaluation of intensive interaction in community living settings for adults with profound intellectual disabilities.

Abstract Intensive interaction is an approach to enhancing the communication and social abilities of people with profound intellectual disabilities using principles from care giver-infant interaction. This study showed that practitioners learned to use mirroring and contingent responding, and participants’ abilities to look at faces and become engaged in interaction and joint focus developed. There was less evidence for improved quality of relationship.

Author LEFEVRE Michelle TANNER Karen LUCKOCK Barry

Title Developing social work students’ communication skills with children and young people: a model for the qualifying level curriculum.

Reference Child and Family Social Work, 13(2), May 2008, pp.166-176.

Abstract Currently, there is no explicit requirement for qualifying level social workers to be skilled in communicating with children. But more practitioners believe a basic competence in such skill would be a benefit. The authors present a framework for understanding those components of skilled communication with children that should be included in the qualifying curriculum. A whole programme approach to curriculum development is outlined which, it is suggested, might enable students to develop the knowledge, capabilities and values required for skilled practice in this area.

Author WALKER Jim

Title Communication and social work from an attachment perspective.

Reference Journal of Social Work Practice, 22(1), March 2008, pp.5-13.

Abstract Two theories of communication are explored and described: first, the sequence between the infant and the primary care giver of attunement, rupture and repair. It is argued that this pattern is present in all relationships and that negative aspects can emerge later. Second, the concept of reflective function is explored that has particular relevance to social work. Suggestions are made as to how training courses can enable social workers to improve their communication skills.

Author: FORRESTER Donald et al.

Title: How do child and family social workers talk to parents about child welfare concerns?

Abstract: Working with parents in relation to child welfare concerns is challenging. Social workers are expected to combine working in partnership with ensuring that the focus remains on the child’s needs and protection. To date, most research in this area has relied on retrospective accounts from parents or workers. The current study explored the responses of 40 social workers from seven London authorities to nine vignettes, six of which were textual prompts based on the Helpful Responses Questionnaire, and three further verbal prompts designed to reflect typical resistance comments found in working with parental alcohol misuse. Responses were taped and rated. Overall, social workers tended to use a very confrontational and at times aggressive communication style. This was so consistently observed that it is likely to be a systemic issue. In conclusion, it is argued that at the levels of research, theory and official guidance, insufficient attention has been give to the micro-skills involved in safeguarding children and that this is an urgent priority for further work.

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